Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis.

Mithilesh K. Das, Hussam Suradi, Waddah Maskoun, Mark A. Michael, Changyu Shen, Jonathan Peng, Gopi Dandamudi, J. Mahenthiran

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240 Scopus citations


BACKGROUND: Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration >or=120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. METHODS AND RESULTS: Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads. ECG analyses of 879 patients (age, 66.7+/-11.4 years; male, 97%; mean follow-up, 29+/-18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (P=0.017). CONCLUSIONS: f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality.

Original languageEnglish (US)
Pages (from-to)258-268
Number of pages11
JournalCirculation. Arrhythmia and electrophysiology
Issue number4
StatePublished - Oct 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Das, M. K., Suradi, H., Maskoun, W., Michael, M. A., Shen, C., Peng, J., Dandamudi, G., & Mahenthiran, J. (2008). Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circulation. Arrhythmia and electrophysiology, 1(4), 258-268.